DESCRIPTION: (after application) There is an urgent need in the post-acute care/rehabilitation community for a more practical yet precise system to measure disability outcomes across a continuum of care settings and services. The long-term objective of the proposed project is to achieve a major transformation in the technology used to evaluate disability outcomes for post-acute care. This project amplifies work underway in the Boston University (BU) Center for Measuring Outcomes funded by the National Institute of Disability and Rehabilitation Research (NIDRR). The specific aims of this project are: 1) to build a computer adaptive testing (CAT) system and to determine the accuracy of CAT algorithms in measuring activity outcomes (execution of tasks during daily routines) and participation outcomes (involvement in life situations) by comparing computer-simulated CAT scores with full-length fixed forms; and 2) to test the comparability, validity and responsiveness of CAT disability scores. The project aims will be addressed by means of two major field studies. In Field Study #1, activity and participation data will be collected from 600 patients/instrument in four post-acute care settings, and these data will be combined with item pool data currently being collected by the BU Center for Measuring Outcomes. Item response theory and other statistical methods will be used to evaluate the structure of the activity and participation item pools, establish item calibrations, and create algorithms for a CAT system for disability outcomes assessment. The accuracy of CAT estimates will then be tested using computer simulations. In a subsequent field study, 100 patients/instrument selected from the original sample will be resurveyed to evaluate the comparability of CAT scores to fixed forms, and to determine discriminant validity (across severity groups), and CAT responsiveness to change. The CAT system for post-acute care will radically transform outcome measurement breadth and achieve the practical requirements for routine use in post-acute care settings. Standardizing the instruments used to assess disability outcomes will eliminate the current fragmentation of functional instruments used across post-acute care settings and create an integrated system of outcomes monitoring.